Introduction: The purpose of the study was to quantify the volume of graft that is obtained using sequential upsizing of reamers using the modularity of the second generation Reamer-Irrigator-Aspirator (RIA 2) system and determine any fracture or perforation risk with upsizing. We hypothesize that graft volume may be predicted using radiographic variables that can be measured before reaming. Materials and Methods: Eleven cadaveric specimens were used to evaluate the sequential amount of graft taken using the RIA 2 modular system. Each cadaveric specimen had bone graft harvested from the tibia and femur. Using a radiographic ruler, estimations of the canal size for both the femur and tibia were performed. Average graft volume with SD per incremental increase of reamer was calculated for both the femur and the tibia. Results: There were no perforations of the femur during any reaming. There were 5 perforations or fractures of the tibias during progressive reaming including 3 during the second pass and 2 during the third pass, with a significant increase in perforation in the tibial specimens (P=0.03). There was no significant difference in graft volume after 3 passes from either tibia or femoral harvesting. However, there was a significant decrease in graft volume on the second pass of the femur that was not seen in tibial harvesting (P=0.0013). Discussion: The RIA 2’s reamer head modularity allows multiple passes of the reamer, which gives surgeons the ability to upsize if more autograft is needed. Total autograft volume was similar between the femur and tibia; however, caution should be used in the tibia because of increased perforation risk. Level of Evidence: Level IV—therapeutic study.
Background: Fractures of the talus are a rare but challenging injury. This study sought to quantify the area of osseous exposure afforded by a posteromedial approach to the talus and medial malleolar osteotomy. Methods: Five fresh-frozen cadaveric lower extremities were dissected using a posteromedial approach and medial malleolar osteotomy respectively. Following exposure, the talar surfaces directedly visualized were marked and captured using a calibrated digital image. The digital images were then analyzed using ImageJ software (National Institutes of Health) to calculate the surface area of the exposure. Results: The average square area of talus exposed using the posteromedial approach was 9.70 cm2 (SD = 2.20, range 7.20-12.46). The average quantity of talar exposure expressed as a percentage was 9% (SD = 1.58, range 7.03-10.40). The average square area of talus exposed using a medial malleolar osteotomy was 14.32 cm2 (SD = 2.00, range 11.26-16.66). The average quantity of talar exposure expressed as a percentage was 12.94% (SD = 1.79, range 9.97-14.73). The posteromedial approach provided superior visualization of the posterior talus, whereas the medial malleolar osteotomy offered greater access to the medial body. Conclusion: The posteromedial approach and medial malleolar osteotomy allow for significant exposure of the talus, yielding 9.70 and 14.32 cm2, respectively. Given the differing portions of the talus exposed, surgeons may prefer to use the posteromedial approach for operative fixation of posterior process fractures and elect to use a medial malleolar osteotomy in cases requiring more extensive medial and distal exposure for neck or neck/body fractures. Level of Evidence: Level IV.
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